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Flashcards in 5 Crisis Management Deck (48):
1

What is the definition of crisis?

sudden event in one's life that disturbs homeostasis, during which coping mechanisms cannot resolve the problem

2

Characteristics of a crisis
1. Occurs in _ individuals at one time or another
2. Not equated with __
3. Precipitated by __ __ __
4. __
5. __
6. Potential for __ __ or __

1. all
2. psychopathology
3. specific identifiable events
4. personal
5. acute
6. psychological growth; deterioration

3

The goal of crisis intervention:

resolution of the immediate crisis and restoration of pre-crisp functioning

4

What is the role of the nurse in crisis intervention?

direct, supportive and active

5

In a crisis intervention, methodology focuses on orderly ___-___ and __ __

problem-solving ;
structured activity

6

The focus of crisis intervention is on __

change

7

Name the 4 phases of crisis intervention

1. phase 1 assessment
2. phase 2 planning of therapeutic intervention
3. intervention
4. evaluation of crisis resolution and anticipatory planning

8

Nursing interventions for Crisis Management (10)

1. reality based approach
2. here and now focus
3. unconditional acceptance
4. active listening
5. attend to immediate needs
6. encourage verbalization of feelings
7. set firm limits on aggressive, destructive behaviors
8. acknowledge feelings of anger, guilt, helplessness
9. help client identify source of the crisis
10. clarify the problem

9

What are signs/symptoms of someone who may act out?

What should you do if you see these?

1. pacing
2. clenching fists
3. posturing
4. someone hearing voices
5. isolating themselves
6. grimacing
7. agitated depression

INTERVENE EARLY

10

Problem-solving process for Crisis Management

What are the three key points?

1. Help client begin to identify changes they would like to make
2. explore alternative coping mechanisms
3. identify external support systems

11

What should you do before managing a crisis (if you have time?)

What should you do after the incident?

assess your own self

self reflection

12

What does this describe?
Any disturbance in thoughts, feelings, or actions for which immediate therapeutic intervention is necessary

psychiatric emergencies/crises

13

What can be seen during a psychiatric emergency or crisis?
1.
2.

1. psychosis
2. violence

14

Psychiatric Emergencies/Crises
examples of disorders that can cause violence:
(7)

1. psychoactive substance induced
2. antisocial personality disorder
3. cerebral neoplasm
4. delusional disorder
5. paranoid personality disorder
6. temporal lobe epilepsy
7. manic episode

15

What are 8 things to look for when assessing for potential violent behavior?

1. hx of recent acts of violence
2. verbal or physical threats
3. progressive psychomotor agitation
4. alcohol or drug intoxication
5. command auditory hallucinations
6. acute mania
7. agitated depression
8. personality disorders prone to rage, impulse dyscontrol

16

What does this describe?
Involuntary confinement of a person alone in a room or area where the person is physically prevented from leaving.

seclusion

17

Seclusion may only be used for the management of __ or __-___ ___

violent
self-destructive behavior

18

When seclusion isn't enough and they are still harming themselves/still violent, then put them on __ __ __

4 point restraints

19

Restraint is any manual method or physical or __ device, material, or equipment that immobilizes or reduces the ability of a person to move his or her __, __, __ or __ freely.

mechanical

arms, legs, body, head

20

How can a drug or medication be used as a restraint?

when the drug is used to manage a person's behavior or restrict the person's freedom of movement and is NOT a STANDARD TREATMENT or DOSAGE for the person's condition

21

What does the position statement state under the APNA Standards?

Articulates both the vision of eliminating seclusion and restraint as well as the principles that support these standards

22

When are seclusion and restraints initiated?

when least restrictive measures have proven ineffective and the behavioral emergency poses serious and imminent danger to the person, staff, or others

23

Seclusion and Restraints are used when the risk associated with ___ to take __ __ outweigh the risks of HARM associated with seclusion and restraint

failure
immediate action

24

Initiation of Seclusion and Restraint:
Necessary measures to protect person's __, __, and __ are in place

dignity
privacy
confidentiality

25

If a client is on seclusions or restraints, what are the 4 standards of care?

1. secluded persons are never left alone in a locked room
2. within one hour of initiation of seclusion or restraint, person must be seen by a physician, licensed independent practitioner (LIP), RN, PA
3. continuous monitoring
4. assessed by RN Q1 hour

26

Rates of Workplace Violence in:
1. ___/1000 workers in all occupations
2. ___/1000 among physicians
3. ____/1000 among nurses
4. ___/1000 in psychiatrists and mental health are professionals

1. 12.6
2. 16.2
3. 21.9
4. 68.2

27

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

male

static

28

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

depression

dynamic

29

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

previous history of violence

static

30

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

history of head trauma

static

31

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

history of military service

static

32

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

impulsivity

dynamic

33

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

substance use

dynamic

34

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

persecutory delusions

dynamic

35

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

treatment non-adherence

dynamic

36

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

weapons training

static

37

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

lower intelligence

static

38

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

hopelessness

dynamic

39

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

past diagnosis of major mental illness

static

40

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

young adulthood

static

41

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

suicidality

dynamic

42

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

command hallucinations

dynamic

43

Is this a STATIC risk factor for violence or DYNAMIC risk factor for violence?

access to weapons

dynamic

44

What are some nursing interventions for treating a crisis/a violent client? (6)

1. perform risk assessment
2. increased nursing staff
3. staff training in de-escalation techniques
4. observe client for escalation of anger/agitation
5. intervene at the earliest signs
6. ensure that there are sufficient staff to intervene

45

Increase in violence has been associated with a decrease in...

permanent nursing staff

46

Name 14 de-escalation techniques

1. stay calm
2. manage your own response
3. set limits
4. handle challenging questions
5. prevent a physical confrontation
6. undivided attention
7. nonjudgmental attitude
8. focus on feelings
9. allow silence
10. clarify messages
11. develop a plan
12. team approach
13. recognize personal limits
14. debrief

47

6 techniques for dealing with the aggressive patient

1. start with least restrictive
2. talking down
3. physical outlets
4. medication
5. seclusion
6. restraints

48

Name 6 nursing diagnoses

1. ineffective coping
2. anxiety
3. risk for self - or other-directed violence
4. rape trauma syndrome
5. post-trauma syndrome
6. fear